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Covers surgery to replace ends of both bones in a damaged joint to create new joint surfaces. Includes slideshow on hip replacement. Looks at why it is done and how well it works. Discusses what to expect after surgery and living with a hip replacement.

Hip Replacement Surgery

Surgery Overview

Total joint replacement involves surgery to
replace the ends of both bones in a damaged joint to create new joint
surfaces.

Total hip replacement surgery uses metal, ceramic, or plastic parts to replace the ball at the upper end of
the thighbone (femur) and resurface the hip socket in the
pelvic bone.

Doctors may attach replacement joints to the bones with or without
cement.

Cemented joints are attached to the existing
bone with cement, which acts as a glue and attaches the artificial joint to the
bone.

Uncemented joints are attached using a porous coating that is
designed to allow the bone to adhere to the artificial joint. Over time, new
bone grows and fills up the openings in the porous coating, attaching the joint
to the bone.

Doctors often use general
anesthesia for joint replacement surgeries, which
means you'll be unconscious during surgery. But sometimes they use regional
anesthesia, which means you can't feel the area of the surgery and you are
sleepy, but you are awake. The choice depends on your doctor, on your overall
health, and, to some degree, on what you prefer.

Your doctor may
recommend that you take antibiotics before and after the surgery to reduce the
risk of infection. If you need any major dental work, your doctor may recommend
that you have it done before the surgery. Infections can spread from other
parts of the body, such as the mouth, to the artificial joint and cause a
serious problem.

Minimally invasive surgery

Some doctors are doing hip replacement surgery
through smaller incisions. This is called minimally invasive surgery. It may
mean less blood loss and a smaller scar. But it can also mean a longer time in
surgery, because the surgery is harder to do. And if the new hip cannot be
fitted properly through the smaller incision, the doctor may have to make a
larger opening anyway. These surgeries can also require special equipment that not all hospitals have. Minimally invasive surgery is not done often for hip
replacement. If you are interested in this type of surgery, talk to your
doctor. Whether the procedure is a good idea for you depends on your doctor's
opinion and also on his or her training and practice.

What To Expect After Surgery

Right after surgery

You will have intravenous (IV)
antibiotics for about a day after surgery. You will also receive medicines to
control pain and perhaps medicines to prevent blood clots. It
is not unusual to have an upset stomach or feel constipated after surgery. Talk
with your doctor or nurse if you feel ill.

When you wake up from
surgery, you may have a
catheter, which is a small tube connected to your
bladder, so you don't have to get out of bed to urinate. You may also have a
compression pump or compression stocking on your leg, which squeezes your leg
to keep the blood circulating and to help prevent blood clots. And you may have
a cushion between your legs to keep your new hip in the correct position.

Your doctor may teach you to do simple breathing exercises to
help prevent congestion in your lungs while your activity level is reduced.
You may also learn to move your feet up and down to flex your muscles and keep
your blood circulating. And you may begin to learn about how to keep your hip
in the correct positions while you move in bed and get out of bed.

The first few days

You will probably still be
taking some medicine. You will gradually take less and less pain medicine. You
may continue medicines to prevent blood clots for at least ten days after surgery.

Rehabilitation (rehab) after hip replacement surgery may vary depending
on whether the surgeon used cement or cementless methods to attach the joint
replacement surfaces. Whether your surgeon used cement also determines how much
weight you can put on your leg. Your surgeon will let you and your rehab team
know what limitations you have. You'll probably need a walker, a cane, or crutches for several
weeks.

In general, most people get out of bed with help on the day
of surgery or the next day. Over the next few days, you will learn how to walk with a walker
or crutches. Your physical therapist and sometimes an occupational therapist
will teach you how to exercise, walk, and do activities such as dressing and
cooking while you allow your hip to heal. Depending on the type of surgery you
had and your doctor's instructions, you may learn the following precautions to
keep your hip from dislocating:

Avoid combinations of movement with your new
hip. For example, do not sit with your legs crossed, because in that position
you both bend your hip and bring your hip across your body.

Your
doctor may not want your hip to bend more than 90 degrees. If so, your
therapist may suggest these ideas:

Do not sit on low chairs, beds, or
toilets. You may want to get a special raiser for your toilet seat
temporarily.

Do not raise your knee higher than your
hip.

Do not lean forward while you are sitting down, or as you sit
down or stand up.

Do not bend over more than 90 degrees. This means
you can't bend down to tie your shoes for a while.

For about 8 weeks, your doctor may not want
your leg to cross the center of your body toward the other leg. If so, your
therapist may suggest these ideas:

Do not cross your legs.

Be
careful as you get in or out of bed or a car, so your leg does not cross that
imaginary line in the middle of your body.

Your doctor may not want your leg to rotate in
or too far out. If so, your therapist may suggest that you keep your toes
pointing forward or slightly out.

Most people go home within a few days to a week after
surgery. Some people who need more extensive rehab or those who don't have
someone who can help at home go to a specialized rehab center for more
treatment.

Continued recovery

After you go home, monitor the
surgery site and your general health. If you notice any redness or drainage
from your wound, notify your surgeon. You may also be advised to take your
temperature twice each day and to let your surgeon know if you have a fever
over 100.5°F (38.1°C).

For a while, you may need to sit only in high chairs (not on low seats
that flex your hip more than 90 degrees), use a toilet seat raiser, and sleep
on your back.

You may need to use a walker or crutches for several
weeks after surgery until you can bear your full weight, have less pain, and
can safely move around without falling. How long you need to use crutches or a
walker depends on the condition of your bones and what type of procedure your
doctor used as well as his or her experience working with other people who had
similar surgery.

Physical therapy typically continues after you go
home from the hospital until you are able to function more independently. Total
rehabilitation after surgery will take at least 6 months.

You will
have an exercise program to follow when you go home, even if you are still
having physical therapy. You should also take a short walk several times each
day. If you notice any soreness, try a
cold pack on your hip and perhaps decrease your activity a bit, but don't
stop completely. Staying with your walking and exercise program will help speed
your recovery.

For most people it is safe to have sex about 4 to 6
weeks after a hip replacement. Talk to your doctor about how and when it is
safe. And ask your physical therapist or occupational therapist about positions
that will not put your new hip joint at risk.

Living with a hip replacement

Your doctor will
probably want to see you at least once every year to monitor your hip
replacement. Gradually, you will return to most of your presurgery activities.
If you drive a car, your doctor will probably allow you to start driving an
automatic shift car in 6 to 8 weeks, as long as the seat is not too low and you
are no longer taking pain medicine.

Because of the way the hip is
structured, every added pound of body weight adds 3 pounds of stress to the
hip. Controlling your weight will help your new hip joint last longer.

Stay active to help
keep your strength, flexibility, and endurance. Your activities might include
walking, swimming (after your wound is completely healed), dancing, golf (don't
wear shoes with spikes, and do use a golf cart), and bicycling on a stationary
bike or on level surfaces. More strenuous activities, such as jogging or
tennis, are not advised after a hip replacement.

Your doctor may
want you to take antibiotics before dental work or any invasive medical
procedure for at least 2 years after your surgery. This is to help prevent
infection around your hip replacement. After 2 years, your doctor and dentist
will decide whether you still need to take antibiotics. Your general health and
the state of your other health conditions will help them decide.

Why It Is Done

Doctors recommend joint replacement
surgery when hip pain and loss of function become severe and when medicines and
other treatments no longer relieve pain. Your doctor will use X-rays to look at
the bones and cartilage in your hip to see whether they are damaged and to make
sure that the pain isn't coming from somewhere else.

Total hip
replacement may not be recommended for people who:

Have poor general health and may not tolerate
anesthetic and surgery well.

Are severely overweight (replacement joints may be more
likely to fail in people who are very overweight).

But doctors evaluate each person individually.

How Well It Works

People who have hip replacement
surgery have much less pain than before the surgery and are usually able to
resume daily activities. You will probably be able to do your daily activities
more easily because the joint moves better.

It probably will be easier for you to do things
such as climb stairs, get in and out of a car, walk without tiring, walk
without a limp or with less of a limp, and take care of your
feet.

You probably will be able to resume activities, such as
golfing, biking, swimming, or dancing, that you did before
surgery.

Your doctor may discourage you from running, playing
tennis, and doing other things that put a lot of stress on the joint.

Most artificial hip joints will last for 10 to 20 years or
longer without loosening, depending on such factors as:

Your lifestyle and how much stress you put on a
joint.

How much you weigh (being very overweight puts extra stress
on the joint).

How well your new joint and bones mend.

The younger you are when you have the surgery and the more
stress you put on the joint, the more likely it is that you will eventually
need a second surgery to replace the first artificial joint. Over time, the
components wear down or may loosen and need to be replaced.

Your
artificial joint should last longer if you are not overweight and if you do not
do hard physical work or play sports that stress the joint. If you are older
than 60 when you have joint replacement surgery, the artificial joint probably
will last the rest of your life.

Doctors continue to discover new
ways to improve the life span of artificial hip joints. What we know today
about the long-term outcomes of hip replacement surgery comes from studies of
joints that were replaced 10 to 20 years ago or longer. People who have hip
replacement surgery today may expect the artificial joint to last longer than
joints replaced 10 to 20 years ago.

Risks

The risks of hip replacement surgery can be
divided into two groups:

Risks of the surgery and recovery
period

Long-term risks that may occur months to years after the
surgery

The risks of each complication depend in part on your other
health problems and on the surgeon.

Risks of the surgery and recovery period

Blood clots. People may develop a blood clot in a
leg vein after hip joint replacement surgery. Blood clots can be dangerous if
they block blood flow from the leg back to the heart or if they move to the
lungs. Blood clots are more common in older people, those who are very
overweight, those who have had blood clots before, or those who have cancer.

Infection in the surgical wound or in the joint. Infection is rare in people who are otherwise healthy.
People who have other health problems, such as diabetes, rheumatoid arthritis,
or chronic liver disease, or those who are taking corticosteroids are at higher
risk of infection after any surgery. Infections in the wound usually are
treated with antibiotics. Infections deep in the joint may require more
surgery, and in some cases the doctor must remove the artificial joint. If the
joint pieces have to be removed, they are usually replaced. But that surgical
procedure (revision) is more complicated than the original hip replacement and
has a greater risk of problems.

Nerve injury. In rare cases, a nerve may be
injured around the site of the surgery. This is more common (but still unusual)
if the surgeon is also correcting deformities in the joint. A nerve injury may
cause tingling, numbness, or difficulty moving a muscle. These injuries usually
get better over time and in some cases may go away completely.

Problems with wound healing. Wound healing
problems are more common in people who take corticosteroids or who have
diseases that affect the immune system, such as rheumatoid arthritis and
diabetes.

Deposits of bone in soft tissues around the hip joint. This is called heterotopic ossification. It usually doesn't
affect how well the hip works, but it may decrease the range of motion at the
hip. The condition needs treatment (surgery) only if it causes pain or greatly
limits motion.

Hip dislocation after surgery. It is rare to
have a hip dislocation after hip replacement surgery. Your doctor can usually
treat this by moving the hip back into place after giving you pain medicine or
anesthetic. You also may wear a brace for a while. In a few cases, surgery may
be needed to put the joint back in place.

Difference in leg length. Usually, any difference
in leg length is very small and does not cause any pain or functional problem.
If you have a noticeable difference, it can often be corrected by using a shoe
insert.

The usual
risks of general anesthesia. Risks of any surgery
are higher in people who have had a recent heart attack and those who have
long-term (chronic) lung, liver, kidney, or heart disease.

Long-term risks

Loosening of the artificial hip joint parts. Over time, loosening is the most common problem
associated with total hip replacement. Tissue may grow between the components
and the bone, leading to loosening. Loosening usually doesn't cause any
symptoms and is visible only on X-rays. If a loosened joint causes severe pain,
you may need a second joint replacement.

Infection. People who have any sort of artificial
material in their bodies, including artificial joint components, have a higher
risk of infections around the artificial material. They may need to take
antibiotics before and after procedures such as surgery, tests that involve
inserting instruments into the body, and dental work to help reduce the risk of
infection.

After a hip replacement, tiny bits of the surface of the new hip joint wear off as the ball and socket pieces rub against each other. Some people are sensitive to the types of metal that can be used for joint replacements. Tell your doctor about any symptoms related to your hip, groin, or leg that are new or getting worse. And be sure all your health providers know you have a hip replacement.

What To Think About

Continued exercise (such as
swimming and walking) is important for your general well-being and muscle
strength. Discuss with your doctor what type of exercise is best for
you.

You may donate your own blood to use during surgery if
needed. This is called autologous blood donation. If you choose to do this,
start the donation several weeks before the surgery so that you have time to
donate enough blood and rebuild your blood volume before surgery.

If you need more than one joint replacement surgery, such as a knee and a
hip, talk to your doctor about
guidelines that may help you and your doctor
decide in which order to do the surgeries.

References

Other Works Consulted

American Academy of Orthopaedic Surgeons (2009). Activities after hip replacement. Available online: http://orthoinfo.aaos.org/topic.cfm?topic=a00356.

Imamura M, et al. (2012). Single mini-incision total hip replacement for the management of arthritic disease of the hip: A systematic review and meta-analysis of randomized controlled trials. Journal of Bone and Joint Surgery, American Version, 94(20): 1897–1905.

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